Prognostic factors of conversion surgery for stage IV gastric cancer: A multi-institutional retrospective analysis

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2024-01-28 DOI:10.1002/ags3.12778

Atsushi Takeno, Masaaki Motoori, Kentaro Kishi, Takeshi Omori, Motohiro Hirao, Toru Masuzawa, Kazumasa Fujitani, Kazuyoshi Yamamato, Yukinori Kurokawa, Yuichiro Doki

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Abstract

Background

Conversion surgery (CS) is a highly anticipated strategy for stage IV advanced gastric cancer (AGC) with a good response to chemotherapy. However, prognostic factors limiting R0 resection remain unclear. In this multi-institutional study, we investigated the clinical outcomes of CS for stage IV AGC and the prognostic factors of CS-limiting R0 resection and analyzed them according to metastatic patterns.

Methods

Clinical data on 210 patients who underwent CS for stage IV AGC at six institutions between 2007 and 2017 were retrospectively retrieved. The patient background, preoperative treatment, operative outcomes, and survival times were recorded. Prognostic factors for overall and recurrence-free survival were investigated using univariate and multivariate analyses for patients who underwent R0 resection.

Results

R0 resection was achieved in 146 (70%) patients. The median survival time was 32 months, and the 3-year survival rate was 45%. Patients who achieved R0 resection had significantly longer survival than those with R1/2 resection (median survival time: 41.5 months vs. 20.7 months). Multivariate analysis identified pathological N positivity for overall and relapse-free survival and pathological T4 for relapse-free survival as significant independent poor prognostic factors of R0 resected patients. There was no significant difference in survival among the peritoneum, liver, and lymph node groups regarding the initial metastatic sites.

Conclusions

CS with R0 resection for patients with stage IV AGC can lead to longer survival. Patients with pathological T4 and pathological N positivity were eligible for intensive adjuvant therapy after CS with R0 resection.

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IV 期胃癌转换手术的预后因素：多机构回顾性分析

对于化疗反应良好的 IV 期晚期胃癌（AGC），转换手术（CS）是一种备受期待的策略。然而，限制 R0 切除的预后因素仍不明确。在这项多机构研究中，我们调查了IV期AGC的CS临床结果以及限制CS R0切除的预后因素，并根据转移模式进行了分析。记录了患者背景、术前治疗、手术结果和生存时间。对接受R0切除术的患者进行了单变量和多变量分析，研究了总生存期和无复发生存期的预后因素。中位生存时间为 32 个月，3 年生存率为 45%。R0切除患者的生存期明显长于R1/2切除患者（中位生存期：41.5个月对20.7个月）。多变量分析发现，病理N阳性（总生存期和无复发生存期）和病理T4阳性（无复发生存期）是R0切除患者显著的独立不良预后因素。就初始转移部位而言，腹膜组、肝脏组和淋巴结组的生存率无明显差异。病理T4和病理N阳性的患者可在CS R0切除术后接受强化辅助治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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